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Hydromorphone cost-effectiveness

Injectable hydromorphone treatment for severe opioid use disorder may reduce mortality and save costs to society compared to providing methadone alone.

The findings come from an economic analysis of the groundbreaking SALOME trial, published in Addiction.

In this economic assessment, researchers compared the economic outcomes of the 202 individuals included in the SALOME trial and used the findings of NAOMI and SALOME as a basis for lifetime individual projections of risk of mortality, and approximate costs of treatment, involvement in crime, and other health care utilization. These costs included opioid substitution treatment, treatment for HIV infection, other health care use, self-reported criminal activity, and criminal charges.  The actual cost savings depend on the negotiated drug price and costs related to drug product preparation.

SALOME (Study to Assess Longer-term Opioid Medication Effectiveness) originally found injectable hydromorphone, a licensed opioid also known as Dilaudid, to be as effective as diacetylmorphine (pharmaceutical heroin) for people who have not benefited from previous treatments, such as methadone or suboxone.

SALOME is the follow-up study to the North American Opiate Medication Initiative (NAOMI), North America’s first-ever clinical trial of diacetylmorphine/prescription heroin as an opioid agonist treatment medication.

“This groundbreaking BC research supports the Ministry of Mental Health and Addictions work to offer a full spectrum of treatment options so that more people with opioid addiction can find a pathway to hope and recovery that works for them,” said Judy Darcy, Minister of Mental Health and Addictions. “The goal of everything we are doing is to save more lives and connect more people to treatment and recovery services as soon as possible.”

“Our results suggest that funding injectable hydromorphone, a legally approved pain-management drug, reduces mortality, increases quality of life and saves overall costs, when compared to methadone alone.” said lead author Dr. Nick Bansback, researcher at the Centre for Health Evaluation and Outcome Sciences (CHÉOS) at St. Paul’s Hospital and associate professor at the UBC School of Population and Public Health.

Although the direct cost of hydromorphone is higher than methadone, the study indicated these costs would be saved by retaining individuals in treatment for longer, and consequently reducing the hospitalizations and criminal activity that rise when people are not retained in any treatment. Dr. Bansback adds, “The results are similar between hydromorphone and diacetylmorphine, but since hydromorphone is already a licensed opioid, this might be more straightforward treatment to implement.”